Impact of isolation on the use of technology by older adults with Type 1 Diabetes during the COVID-19 Pandemic (Preprint)

BACKGROUND Background: The COVID-19 lockdown imposed a sudden change in lifestyle with self-isolation and a rapid shift to the use of technology to maintain clinical care and social connections. OBJECTIVE Objective: In this mixed-methods study, we explored the impact of isolation during the lockdown on the use of technology in older adults with Type 1 Diabetes (T1D) METHODS Methods: Older adults (age ≥65 years) with T1D using continuous glucose monitoring (CGM) participated in semi-structured interviews during the COVID-19 lockdown. A multidisciplinary team coded the interviews. In addition, CGM metrics from a subgroup of participants were collected before and during the lockdown. RESULTS Results: We evaluated 34 participants (age 71±5 years). Three themes related to technology use emerged from the thematic analysis regarding the impact of isolation on: 1) insulin pump and CGM use to manage diabetes including timely access to supplies, and changing Medicare eligibility regulations; 2) technology use for social interaction, and 3) telehealth use to maintain medical care. The CGM data from a subgroup (n=19; age 74±5 years) showed an increase in time in range (57±17 vs 63±15%; p= 0.001), a decrease in hyperglycemia (>180 mg/dL) (41±19 vs 35±17; p< 0.001), and no change in hypoglycemia (<70 mg/dL) (0.7% vs 1.1%) during the lockdown, compared to before. CONCLUSIONS Conclusion: These findings show our cohort of older adults successfully used technology during isolation. Participants provided positive and negative perceptions of technology use. Clinicians can benefit from our findings by identifying barriers to technology use during times of isolation and developing strategies to overcome these barriers. CLINICALTRIAL Clinicaltrials.gov NCT03078491